Skip to main content

Should rheumatologists treat fibromyalgia patients?

I do believe there are patients who have widespread musculoskeletal pain attributed to a syndrome we call fibromyalgia. However, I do not believe rheumatologists should be the "main caregivers for these patients," as Pisetsky and others have suggested. We simply treat these patients by default. The main reason for my stance is the lack of any creditable evidence supporting fibromyalgia as a rheumatologic condition other than the existence of chronic pain. Although rheumatic diseases are often associated with chronic pain, the converse is not necessarily true. With the burgeoning entrepreneurial specialty masquerading as "pain management," my opinion is that these patients would be best served by those who claim to be pain specialists—if only we could get them to put their needles down long enough to actually treat the pain and the patient.




Dr Pisetsky states FMS is not a rheumatic diseases and therefore not under the realm of what a rheumatologist should be treating. I actually do not disagree. I agree that a rheumatologist is the specialist to be seen to get a FMS diagnosis, but I doubt they are great in the treatment department. The first one I saw, because I presented symptoms of lupus or RA, told me I had 'hypermobility sundrome with chronic soft tissue pain' and that was that. The second one I went to said I had FMS but that I was too young for any medications and that was that. Thanks. So very helpful. While the symdrome shares some symptoms with diseases these specialists do treat I find they flounder with FMS, reluctant to treat pain as pain and wishy washy about what to do. Which leaves the FMS patient pretty much in limbo. There general doctor will often not be able to fill the gap, they may try a few things, but pain management is beyond them. It is the reason I have never had any effective treatment of this syndrome and it has kinda fell to the side in the face of chronic migraines. I think a pain management clinic is the way to go, pretty much the only way to go. So the dude is right, if I had FMS and I was his patient I would totally ditch him.

On the other hand the reply to this article suggests otherwise:

Who else can manage fibromyalgia better than a dedicated and caring rheumatologist? We are the best diagnosticians, bar none. We are better at using drugs than anybody else, even with our hands tied behind our backs. Managing a fibromyalgia patient is like having one's hands tied behind one's back. Furthermore, drugs don't work very well in these patients, and just telling a patient that they must exercise also does not work. As I write this, I realize that in some respects managing a fibromyalgia patient now is somewhat akin to what is was like managing a rheumatoid 35 years ago when I started practice. Maybe that is why I am not resentful in having to take care of these patients.

It has occurred to me that if I were not able to use opioids in the management of fibromyalgia, then I, too, would lose interest in taking care of these patients. Opioids are to fibromyalgia what corticosteroids are to rheumatoid arthritis. We try to avoid them if possible, but when they are necessary—which is often—we should employ them. Maybe, just maybe, Dr Luetkemeyer refuses to give these patients opioids for whatever reason. If that is the case, I could understand his frustration and his decision not to treat these patients.
-- Dr Murray Sokoloff



Now that doc sounds like he would go the course with his patients, FMS or otherwise. I want him at my back any day. He suggests some may not want to treat FMS because it is difficult to treat, and I think that is the very reason... so recipe to follow and no sure results. He points out that RA back in the day had no easy treatments either. So all specialists are not born equal it seems. Pity in small areas we simply cannot pick and choose.
Post a Comment

Popular posts from this blog

Signs the pain is getting the best of you

100 Symptoms of Fibromyalgia

There was a site that had this and I had linked to it on Tumblr but it is gone. So I had to hunt down someone who found my post and posted the whole thing in a forum. Anyway it is around but I'm posting it here so I will not have to hunt it down to reference it. Now we all know the major symptoms are the wide-spread pain, but our pain isn't just muscle pain... it can be nerve types of pain as well, and the fatigue and the insomnia. And even among symptoms there are some far more frequent than others, but it should be said we have categories... like the cognitive dysfunction, which is a broad one that has more than one symptom and we often just say fibrofog. The insomnia... more than one sleeping disorder. So the list is interesting.




GENERAL
__ Fatigue, made worse by physical exertion or stress
__ Activity level decreased to less than 50% of pre-illness activity level
__ Recurrent flu-like illness
__ Sore throat
__ Hoarseness
__ Tender or swollen lymph nodes (glands), especiall…

When I say I am good

When people ask me how I am feeling 99% of the time I am lying. I often say 'not bad', because I feel it is slightly more honest than 'good' or 'fine'. Got sick of fine. Anyway, I lie for many reasons. 



I'm having a good pain day: They happen and I'll say that I'm good, fine, not bad. I even feel like I can accomplish great things... in moderation. In which case, relatively speaking, for Me I am not actually lying. This is a Good pain day, it is Not Bad for me and I am Fine with it. I just don't want to explain: I just don't want to explain how crappy I feel and in which way I mean. Because I am tired of it. I just want to deal with it, without having to discuss it, mention it or have any sympathy expressed about it. Because it can be complicated. It may be a migraine with specific symptoms. Maybe it is a FM flare though. Or both. And then I have to explain what it is because most people think my migraines are the main issue but I could be FM…